Diagnosis and Treatment of States of Shock

Abstract

Shock remains a diagnosis of significant mortality and morbidity. The current definition defines shock as an acute clinical syndrome that results from inadequate tissue perfusion, which is significantly different from the previous definition of hypotension. Clinical manifestation varies broadly, and is based on the underlying etiology, degree of organ perfusion, and previous organ dysfunction. This review covers the classification, pathogenesis and organ response, evaluation, and management of shock. Figures show the balance between oxygen delivery and oxygen consumption, perfused capillary density, the Krogh Cylinder Model demonstrating the Anoxic-Hypercapnic Lethal Corner, the relation between systolic blood pressure, mean arterial pressure, and diastolic arterial pressure, glycolysis, and the approach to the patient with shock. Tables list clinical and metabolic markers of perfusion alteration to the organs, hemodynamic parameters in different types of shock, normal hemodynamic parameters, problems associated with the use of pulmonary artery catheter, clinical presentation of hypovolemic shock according to severity, causes of cardiogenic shock and cardiogenic pulmonary edema, and receptor activity of different vaspressors and clinical indication. This review contains 6 figures, 7 tables, and 55 references. Key Words: Shock; Hypovolemic shock; Cardiogenic shock; Neurogenic shock; Vasogenic shock; Septic shock; Obstructive shock